Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutFOX HILL BLK 2 LT 1Fox Hill
Block 2
Lot 1
#051-073-07
\ Municipality of Anchorage
.,, Development Services Department
Building Safety Division : €
Onsite Water 8 Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3
Onsite Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW070300 PID Number. 051-073-07
Name: SALLY GOBLE
Wastewater System: ❑ New ■ Upgrade
Address:
PO BOX 671214 a CHUGIAK, AK 99567
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 242-1564 3
0Deep Trench ■Shallow Trench 0Bad ONound 0Other
LEGAL DESCRIPTION
Sall RaUN:
0.8
Total Depth hem crlgi hada:
8 MAX
olD/Sg. n
n
Block: Lot: Subdivision:
apth w Pb. bottan, tram ono" grad.:
Gravel depth beneath pip.:
2 1 FOX HILL
SEE DWG. n
4.02 n
Township: Range: Section: —
— —
N added obab onglnal grod•:
GravN I."stls
57
SEE DWG. rt.
n
Gnwel widay.
NaniMr of Sne.:
DWa s !teem enee:
WELL: ❑New [I Upgrade
5 n
1
— n
Clowmfi or, private. A.S.0 : Total Dw
Cawed T.:(,..00R)
Total ob• tion mea:PiD.
mot~
D 3034/ F-810
n.
n
570 SO. n
auw W. Dnued:
stork water Lay.t
Wdlan..
GEG, Ltd.
We "w1wl:
11/7-12/2007
n
1'wld:
pump set Ae:
Co ming Iblght Above Grwwwl:
TANK
GPN
n
n
SEPARATION
DISTANCES
■septic 0Holding 0S.T.E.P. 0Other*
To
Septic
Absorption
I
Lift
Holding
bk/Prtwta
11OM11OC1vrw,.
ANCHORAGE TANK
Cop«�b
1000
From
Tank
Field
Station
Tank
sewer un.e
well
too'+
100'+
—
—
25'+
t/ot..l.t
STEEL
Nwnb.r of aompar -2
Surface water
100'+
too'+
—
—
—
LIFT STATION
Lot Una
5'+
10'+
—
—
—
Su. In gaily :
tdonulactvw:
ow beet a:
.L
lYgh water abrin eL
Foundation
5'+
10'+
—
—
—
=at,
ptwnp Nob
D.abka kwp.atkwa pwfa br:
Curtain Drain
NONE
KNOWN
BENCH MARK
Remcrks:OLD SEPTIC TANK WAS PUMPED CRUSHED
teeatian and a.arlpwn:
AND COMPLETELY ABANDONED.
BOTTOM OF SIDING ® SOUTH END OF THE HOUSE
Aew,med ENwtkn:
135.53 n
ENCANEER's SEAL
Inspections performed by: GEG, Ltd. Dates: 1st 11/7/2007
0
2nd 11/8/2007
F
OF
3rd 11/12/2007
.S�OpO
Development Services Department Approval
p'?; y°.QQ
.
Conditional approval: Date:
.
' '
r A... ass
QQ� `
CE—
Reviewed and approved by: Date:
oalProfessta�oa�
�D�pppO
(Rev. 4/06)
PERMIT NUMBER:
SW070300
STI
56.87 79.39
ST2
60.78 85.25
D8L1
62.80 87.53
DBL2
64.28 89.44
C01
117.67 133.04
MTI
116.44 129.47
CO2
110.94 107.07
MT2
112.36 109.18
AS -BUILT DRAWING
I I \\
1 1
I 1
1 1
1 �
I �
PARCEL ID NUMBER:
051-073-07
i
IIXISTING TRENCH
MFZr
/ � B
NEW DRAINFIELD—
/ y 41.
INSTALLED BULL
RUN VALVE
�1
S LIE: CP°
Y- 40'
� � I
V 1000 GALLON
SEPTIC TANK
FOX HILL S/D.
LOT2. BLOCK 2
GARNGSS ENGINEERING GROUP, Ltd.
-- •- - CONSULTANTS 6 GENERAL CONTRACTORS—
=1
ONTRACTORSr-mi L n NWA w loi . w 3otu t M r.. portvs ".
PREPARED FOR: PHONE NUMBER: PACE NUMBER:
SALLY GOBLE 242-1564 2 OF 3
LEGAL DESCRIPTION:
FOX HILL SUBDIVISION. LOT 1. BLOCK 2
TYPE OF WORK:
AS—BUILT
BY: V u •mac—/yJJ
K.D.M. O��ne�-'' (.it13/q'Gc
11/12/2007
TOP OF TANK -
AT INLET = 104.38
INVERT OF BUNG -
AT INLET = 103.93
TH#1
ORIGINAL GRADE
= 90.65
FINAL GRADE = 108.34+
ST1 ST2
TOP OF TANK
I -R-, /AT OUTLET = 104.40
NEW 1000 GALLON
SEPTIC TANK
T
1
-INVERT OF BUNG
AT OUTLET = 103.69
FINAL GRADE =92.59
.TER FABRIC
INVERT OF PIPE
= 86.67
I 5� '*'�,— BOTTOM OF TRENCH = 82.65
GARNLSS ENGINEERING GROUP, Ltd. p°¢'?:' 4 .7`
- -- ..
CONSULTANTS& GENERAL CONTRACTORS // ......•••••
e
.. Y"""
Ml G new A sort 10t • .wssw
0044M r r • r (W?)l rein • rM (br)us-• • .mne w..w�M�Mae.
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: •••••• •••••••••••
SALLY GOBLE 242-1564 3 OF 3 OO p '•.J If r y rnessi
LEGAL DESCRIPTION: DRAWN BY: OO°yv CE 3
FOX HILL SUBDIVISION, LOT 1, BLOCK 2 K.D.M. 04'ere it}�43 ��Ad
TYPE OF WORK: DATE: 4�Q�Y'rof essiov'o`o
PROFILE ASBUILT 11/12/2007 D�O000���
6y_f
SEWARD & ASSOMKILZI t cony
ASBUILT SCALE, +OF Ate
~ �� � �-I
I HEP.EBY
CERTIFY THAT SURVEYED THE � �F A..
AT I HAVE / � ••`
DATE' r�P;
FOLLOWING DESCRIBED PROPEKTY�
MFRBS EXIST
HMENTS EXCEPT AS
AND THAT NO F' IS H••"
INDICATED. IT IS THE RESPONSIBILITY
OF OF
GRID
OWNER TO DETERMINE THS EX , Duane Merle y,werA
EASEMENTS, COVENANTS, OR RESTRIC710NS
WHICH DO NOT APPEAR ON THE RECORDED SUHW-D
FB*
UNDER NO CIRCUMSTANCES SHOULD
VISION PLAT- FOR CONSTRUCTION
ANY DATA HEREON BE USED D12A0 f
OF FENCE LINES, OR FOR ESTABLISHING, BOUND- : —
ARY LINES.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water B Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519.6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Oct 31, 2007
Expiration Date: Oct 30, 2008
Permit Number: SWO70300 Parcel ID: 051-073-07
Legal Description: FOX HILL BLK 2 LT 1
Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 021936 WOODCLIFF DR
Owner Name: SALLY GOBLE Lot Size: 80211 SO. FT.
Owner Address: PO BOX 671214 Total Bedrooms: 3 Permit Bedrooms: 3
CHUGIAK , AK 99567 -
This permit is for the construction of.
Q Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specked In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By.
Issued By
Date:///) 6
Date: 31 L7
\ Municipality of Anchorage
• '� Development Services Department
Building Safety Division fih7 ice'
On -Site Water a Wastewater Program
4700 Bragaw St.
P.O. Box 196650
Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 05I— D 3- U4
Property owner(s) SALLY GOBLE Day phone 688-5104
Mailing address PO BOX 671214 e CHUGIAK. AK
Site address '�-Ig31r J_Omfy_Lj 'w Zip Code 99567
Legal description (Sub'd, Block & Lot ) FOX HILL, LOT 1. BLOCK 2
Legal description (Township, Section & Range) _N/A
Lot Size X 1, �'_I Sq.Ft. Number of Bedrooms 3
THIS APPLICATION IS FOR ( ®all that apply):
Absorption Field
❑
Septic Tank
19
Holding Tank
❑
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION IS AN:
Initial
❑
Upgrade
19
Renewal
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
Permit/Rush Fees: 116 0 - O (7
Date of Payment:1y�I o 7
Receipt Number: of 5 -% _), _5
(Rev. 11/05)
Waiver Fees:
Date of Payment:
Receipt Number:
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORSa-
October 22, 2007
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907)343-7904
Ref: Proposed Septic Upgrade for Fox hill Subdivision; Lot 1, Block 2,
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The septic system is in a state
of failure and needs to be upgraded. We are proposing to install a 1000 gallon septic tank and a 5 -wide
trench type drainfield. One test hole was excavated on the property. The drainfield will be designed
around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows:
1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the
percolation test results.
2. DRAINF1ELD DESIGN: The existing drainfield will be left in place and connected to the system
with a diverter. If the existing trench is able to recover through sitting idle, it can be alternated yearly with
the new trench to give both absorption fields recovery time. See attached design drawing for drainfield
specifications.
3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system.
4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the
drainfield is a 5-10 percent slope running approximately east to west.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems.
If you have any questions, please contact us at 337-6179. Thank you for your assistance.
Sincerely,
Pte -
Donna C. Mears, P.E., M.U.P.
NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for
this septic systent. (Contact G.E. G. Ltd. for 7 page construction specification letter.)
3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259
Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: www.gamcssenginecring.com
LOT 5. BLOCK 1;
DEER PARK S/D
i
LOT
DEER
LOT 2. BLOCK 2;
FOX HILL S/D
LOT 3. BLOCK 2;
FOX HILL S/D
LOT 4. BLOCK 2;
FOX HILL S/D
0
L \ LOT 1, BLK 3, \
DEER PARK S/D \
O � �
INFERS 1993 T ST HOLE �\
5-10x 44 -1
© 1
TOE OF HILL
_ I
TOP OF
C�12X I
GARNTESS ENGINEERING GROUP, Ltd. p*
^^--•--= CONSULTANTS 6 GENERAL CONTRACTORS ...
ee. 0
>ot c 11gdt euo, trurt tot • wcw�t,cc wt tnror . wto,[ -etn . rur
PREPARED FOR: PHONE NUMBER: PACE NUMBER: 0
SALLY GOBLE 688-5104 1 OF 2 �,
LEGAL DESCRIPTION: DRAWN BY: QO°a
FOX HILL, BLOCK 2, LOT 1 K.D.M. D
(TYPE OF WORK: DATE
PROPOSED UPGRADE SEPTIC SYSTEM DESIGN 1
(Rev. 01ft)
r-
xy .........:,�S�DO
49LH '
•C
'-.DONNA C. ►AE RS•
CE -11135 :,r
0
.�Op�Professbn�� oo/
NUMBER OF BEDR00MS:3
LLT(LR THAT PERTAINS TO
TO OBTAIN A COPY OF
GALLONS PER DAY (GPD): 450
CONTACT OEC. BY PROCEEI
PERCOLATION RATE/S: 10 MIN./INCH
WITH THIS INSTALLATION, T
PROPOSED APPUCATION RATE: 0.8
I
WELL DRILLER, CONTRA
MINIMUM GRAINFIELD SO.FT.: 563
PROPERTY OWNER AGREE
HAVE READ THESE SPECIFI
Mn At rl rl n nrcln„_
AGREE TO ACCEPT THE
MAXIMUM DEPTH:B FEET
WIDTH:5 FEET
LENGT:57 FEET
M.OAHAPPROVED SAND FILTER: N/A I \�
EFFECTNE:4 FEET \
REDUCTION FACTOR: 0.50
ACTUAL S0.FT.: 570 I
/ CONSTRUCTION
/ ENGINEERS 1993
TEST HOLE
EXISTING TRENCH
.__—__ MT1C0 >25%
TH/1� / I IN
[al
LLEEA ODUTTS
PROPOSED DRAINnELD� / V
INiALL ZABEL FLOW
DIVERTOR
OLD SEPTIC TANK TO BE PUMPED,
CRUSHED, AND COMPLETELY
ABANDONED
>23S
TOE OF THE HILL
N
5 E: CP�
I" - 40'
I MV4
/
—1
\\ PROPOSED 1000
GALLON SEPTIC TANK
FOX HILL S/D,
LOT2, BLOCK 2
GARNESS CONSULTANTS ENGINEERING ONTRA�TORS GROUP� , Ltd,
3A1 L TAW AdU, lUIC 101 • A40MAM M1 NJO) • AGK (o0».=) jft • IAM (0017000�NN • .RV . wv.ysn,wywhyya,
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
SALLY GOBLE 688-5164 2 OF 2
LEGAL DESCRIPTION: DRAWN BY:
FOX HILL, LOT 1, BLOCK 2 1 K.D.M.
(TYPE OF WORK:
PROPOSED
SYSTEM
10/18/2007
IJ
odPKX....:....... •.11 mq 0
DONNA C. MEARS.:
CE -11135
. �I1:�._ ' • 10......
GARN SS o NG SNEERING GROUP, Ltd
7 I}llllll POCKECTS
OAND VEL
8
9
10
11
12
13
14•
15-
16-
17-
18-
19-
DEPTH
5•16•17-
18-
19-
DEPTH TO
GROUNDWATER
SOIL LOG
- PERCOLATION TEST
LEGAL DESCRIPTION:
FOX HILL, LOT
1, BLOCK 2
PERFORMED FOR:
SALLY GOBLE
DAl
DEPTH
2
3:30
=Z==
(reef) �yya
ORGANIC
TEST HOLE 1
1 y��7
3:30
—
_
_
SOILCLASSIFICATIONS
2 »»
LOAM
3•
---
5
'b ` 6 s GW -- ORG
----
3
6•
,;�+i GP ML
6
4:30
GMICL
4
3•
GC OL
°• °°• o SWMH
5
•� `'• SP CH
SM OH
6
SC
7 I}llllll POCKECTS
OAND VEL
8
9
10
11
12
13
14•
15-
16-
17-
18-
19-
DEPTH
5•16•17-
18-
19-
DEPTH TO
GROUNDWATER
DATE
10/5/2007
DRY
10/9/2007
DRY
10/12/2007
DRY
6-
_
�o �F'. �r••A�.gS\�
... . ......:...
P •. DONNA C. M ARS.:
CE 11139, e�
°�, e'• /Q. 07.-"oa
0
t0
lsio�°oma/
DATE READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
10/9/2007 1
3:00
—
6-
_
2
3:30
30
3•
3-
3
3:30
—
6•
_
4
4:00
30
3•
3-
5
4:00
—
6•
_
6
4:30
30
3•
3•
PERCOLATION RATE 10 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4 FT. AND 4.5 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO
SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: KYLE MAUS
COMMENTS:
PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:
Municipality of Anchorage Page I of 2-
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONME=NTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 ® Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: — 53'"00 PID Number: _._L�
Name: M
Wastewater System: &-New ❑ Upgrade
Address: - -
_ Pa fax 6 045%- Cttwcs, K
ABSORPTION FIELD
Phone:
68 8 1 Z3 (�
No. o6Bedrooms:
ed
❑ Deep Trench 0 Shallow Trench ❑ Bed ❑ Mound 11 Oth@ r
® ®
w19�' 17rJCH
/'+A
LEGAL DESCRIPTION-Soil
�
Rating:
I 'Z
Total Depth from original grade:
I J t
_
GPU/Sq. Ft.
Lot: Block:�^ Su division:
I Z 4VL-L
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
Tom-' K
a Ft.
Fl.
_
Township:ange:
RSection:)
�
_
Fill added above or ginal grade:
Ft.
Gravel length:
r Ft.
WELL: 'New ❑Upgrade
Gravel defglh: L/i> 1
Numberoflines:
I
Distan!ebetween lines
�
� Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
6
Total absorption area: �G—I�r ��-tvt
j Pipe material: PC$-reA 'P 303'}/
ViiiyA--re
Ft.
Ft.
39.4-- SQ. FL
PwG F$)a
Driller: Date Drilled: Static Water Level:
SuLL1V);t� Ft.
Installer �T Date installed:
MM M �e»,�yu -- 4-7-t 1993
Yield:Pump Set at: Casing Heigh Above Ground:
�
TANK
GPM FL Ft.
_
SEPARATION DISTANCES
kSeptic El Holdingo S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer 4^�
6\(Dy
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
App Q_J�
Well
ICS$
n
0'
N
Material:
S1ea�
Number of Compartments:
Z
pr
Surface
Water
+im
a Jam'
d IUb'
LIVET STATION
Lot
4Gr
31'
43,
Size in gallons:
Manufacturer
Line
Foundation
1CJZ1
c�0
�'
"Pump on" level at:
level aC
High water alarm at:
Curtainfir
)
J �t
5o t
J
Pump Make e Electrical Inspections performed by:
Drain
Remarks:
R
BENCH MARK
_
Location and Description:
Assumed Elevation:
�.��
ENC, 44 REWL
�A f Of At e
A
L�o°lf�fr.y��N®w
Inspections performed by: -ors v 3, _. Dates: lst_$'�Ig3 _
��
5,NJif
2nd-
h1o41�./w�..•P rw�IgM■f�SO4 ®10.
I .�► IYN. r7dAl
5 1i93
p
I/'Juno A 1%6 ag
Department of Health and Hum Aervices appr®"-96"2
/� �
AW
k%S
Reviewed and approved by: _ - Date: _
72-013 (1/91) MOA 25 /
Permlt No. 95-0035
Page — Z' of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: _ L ) 8Z �=O_�< 41LL S vg
f]fiTt'.Z
6
ci
b}QIG•1N�L
} fLIM Sy L��I111—___
<+KAp II
TZ
49=
M 1 RAP1
fill PLV VX L lAifiiL�Yl
Sewat ezcti
�'RCNtI�I
�3oT�tw.
4c'
92 5
411 PVC.
CiaYVomoR
vb
�1'9xS/wx4G'L
M.r,
w 1 «L''MrNCO
9a'�_ WALL
411 PVC.
� G 5
p ,
vb
1000
Z
C-al-r.L
3SCDI�om
9u'PV4 hv�vss
OWDCYL (OiVST.
(c -V 10 H t"V 1) MVA Zb
cLLN 60.0 6 0
J
�6d530
9 9 ° j
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW930039 DATE ISSUED: 3/30/93
DESIGN ENGINEER:CONSTRUCTING ENGINEERS, INC. EXPIRATION DATE: 3/30/94
OWNER NAME:MYERS MICHELLE E
OWNER ADDRESS:P. 0. BOX 670459 / ��/C
CHUGIAK ALASKA 99567
PARCEL ID:05107307
LEGAL DESCRIPTION: FOX HILL BLK 2 LT 1
LOT SIZE: 80211 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
1. MAXIMUM DEPTH TO BOTTOM OF INSTALLATION
2. MODIFIED DESIGN USES SINGLE PIPE RUN IN
WITH CLEAN OUT AT END.
RECEIVED BY:
IS 11.5'.
5' WIDE TRENCH
DATE:
ISSUED BY: i ��� _ DATE:- 2,o/23
SITE PLAN DETAILS ^
PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM
LOT 1 BLOCK 2 FOX HIL]' SUBDIVISION
PREPARED FOR: MR. PAUL MEYERS
PO BOX 670485
CHUGIAK, AK, 99567
SCALE: 1" = 100' DRAWN BY CAL
CONSTRUCTING ENGINEERS 346-2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 3--18-93
DRAWING N 93-S1-03-1
I / !
I
I
/
\ � �
�
No SCPTL �N PR UfroS L-lJl
\
da \ WGLL KhDiV$
100 OF PRO Pdi Llv 1
,
PRqll�
Tbsr HOLFO`
FJZ000Sel) . JGtL
F�! FRon F)Rb l7\T>
3-3DR0Lb
41
LpT %�xr.R 1 ZIl
S f�_-
LEss 5ersrc 5
d
t vvoTPz�n�TSa
>ZS°la
000
( ��^ro EVr_waeD
/
J � 1
!q RCIA AVA1 L1 Le
i
\
r��Z 5 LF
5 ,3 Z a9-
AISSORP' C,o
zoN bo R-6
SITE PLAN DETAILS ^
PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM
LOT 1 BLOCK 2 FOX HIL]' SUBDIVISION
PREPARED FOR: MR. PAUL MEYERS
PO BOX 670485
CHUGIAK, AK, 99567
SCALE: 1" = 100' DRAWN BY CAL
CONSTRUCTING ENGINEERS 346-2000
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 3--18-93
DRAWING N 93-S1-03-1
SCOPE OF PROJECT: New .proposed absorption field is designed for a three (3)
bedroom system. Lot is to be served by private well to be developed on site.
ABSORPTION AREA CALCULATIONS:
Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity
Soils rating, proposed addition, 1.2 gpd/sf
Minimum sizing: 450 gpd = 1.2 gpd/sf = 375 sf absorption area
Due to depth of useable soil, Use wide trench design:
375 sf = 5' W = 125 sf x Correction factor [(W+2):(W+1+2D)]
125 sf x [(5+2) = (5+1+(2)(3))]
�= 44' minimum trench length, 51wide x 3' deep
IMPACT ON ADJACENT LOPS: There are no private wells within 100' of this
proposed absorption system. The proposed absorption system has no
adverse impact upon any adjacent lots as shown on attached site diagram.
✓�,�.�,
SITE PLAN DETAILS
ABSORPTION SYSTEM DESIGN DETAILS --WIDE TRENCH
PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM
v
�T -t�
PREPARED FOR: MR. PAUL MEYER5
SEW E2 dock
T y1A
CHUGTAK, AK, 99567
• ti ,. erg
s >�
rk
CONSTRUCTING ENGINEERS 346-2000
EF
4"Fl?wX HoVSG 6 .5
ANCHORAGE, AK, 99516 3--18-93
DRAWING N 93-S2-03--1
HouSE
z
4" R¢RFoeAticD We Z lL'
" j FNDnI TNG
• SePAfzPt"bw Z!
f
o — ----
� '
Ir
���•-�
Q
x{r S6�lo VC,) PARIF LL 'TZ7 $LOpe
�I' MSN COVh2 6v G'�- PIP[
-
OR\Gir�A\. G2PDi 'k i
00
1 I uG Z" µp 11,jiv i1T)DO Ov¢KTA"-
TYPF'K C"6Z FIE;,t>
M
_-.r
5E UM ROLk ..�! °Sol -XD pvC Ta G1t; o
tj�L Genoe o'-\ ° t N16Nt�`�Yo
ALL CO'( WicomPe% 'Nro SrrcL�M>r„�
Guam � DPN)rJ �.w PY r2on pkL9.
SCOPE OF PROJECT: New .proposed absorption field is designed for a three (3)
bedroom system. Lot is to be served by private well to be developed on site.
ABSORPTION AREA CALCULATIONS:
Minimum Required: 3 Bedrooms x 150gpd/bedroom = 450 gpd capacity
Soils rating, proposed addition, 1.2 gpd/sf
Minimum sizing: 450 gpd = 1.2 gpd/sf = 375 sf absorption area
Due to depth of useable soil, Use wide trench design:
375 sf = 5' W = 125 sf x Correction factor [(W+2):(W+1+2D)]
125 sf x [(5+2) = (5+1+(2)(3))]
�= 44' minimum trench length, 51wide x 3' deep
IMPACT ON ADJACENT LOPS: There are no private wells within 100' of this
proposed absorption system. The proposed absorption system has no
adverse impact upon any adjacent lots as shown on attached site diagram.
✓�,�.�,
SITE PLAN DETAILS
PROPOSED WATER AND WASTEWATER ABSORPTION SYSTEM
LOT 1 BLOCK 2 FOX HILL SUBDIVISION
PREPARED FOR: MR. PAUL MEYER5
PO BOX 670485
CHUGTAK, AK, 99567
• ti ,. erg
s >�
NOT TO SCALE DRAWN 8Y CAL
CONSTRUCTING ENGINEERS 346-2000
EF
9601 BUDDY WERNER DR 694-9098
ANCHORAGE, AK, 99516 3--18-93
DRAWING N 93-S2-03--1
• ae Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: FAVI MectOys
LEGAL DESCRIPTION: I_ 1 `ti 7 -
DEPTH
(FEET) OVca_Y,NC.,
2
3 \ /
1 Stl� gv.Ve�wl
4 / Cnbhtrs
M
7
a �
twc pros L�
9-
10 - S AtvD
11
12
13
14
15
16
17
18
19
20
DATEPERFC
Township, Range, Section: S w �+ 54 -TI SN p,,jJ
SLOPE
SITE PLAN
WAS GROUND WATER
ENCOUNTERED? _ /o
S lV
IF YES, AT WHAT L
DEPTH? O 4
P
E u
Depth to Water Alter
Monitoring? t -A Dale: 3a 10-93
Reading Date
Gross
Time
Net
Time
Depth to
Net
USC 5A"Dy
TEST RUN BETWEEN
Water
Drop
- 3-
5-ETWI'n X -r
�� b uiif F=oNc '5"0QT>T1oY')
�i�P/glfP
I
1��r
1d�e•
�lyl
Z l"
'3
4
Rte,
Y (7 Z,
PERFORMED BY: r "SCA yt`�)�a
CER] IFY THAT THIS TEST
pWAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J7)
j- 1`3-
72-008 (Rev. 4/85)
v
PERCOLATION RATE
�" _ (minutes/inch) PERC HOLE DIAMETER n
USC 5A"Dy
TEST RUN BETWEEN
S
� FT AND 9 S _FT
COMMENTS SOJL
5-ETWI'n X -r
�� b uiif F=oNc '5"0QT>T1oY')
�i�P/glfP
PERFORMED BY: r "SCA yt`�)�a
CER] IFY THAT THIS TEST
pWAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J7)
j- 1`3-
72-008 (Rev. 4/85)
v
JRORRa.PROPERTIES TEL No.907-688-1310 MaY 4,93 9:50 P.01
- r.••+-«,..ay.,... aw.-.: •, '..iv`^`-•'M1�r�w+^-�FiG -ane..,...,....... _ _...s_.
by w7
DOC Co. dba
SULLIVAN WATER WELLS
P.O. BDX670279, CHUGIAK, ALASKA 99567 r TELEPHONE 68sw'9ti
,VNER OF LAND31 C• 1 F+,ti�/1tG r l,t} ti
lf'��..:-�.______. _.�,...._ DEPTH tJlWP:LL d
:)DRESS fil"•iTIL I..itS':l.Cli 6i'.4ILRrr. !.,....
:,CAL DESCRI!''r ONA0i_--( . W. t3RrIV' I'st3ttiM ! (
t'I'[? • Started [-tided .,_3
101111 NUMBER kl N'D0!'CA.MN(-;
ND OF FORMAIJON:
r
gym_.. .._.. FA.rom._•_..,.—Ft. to Ft.,—
Otn..`�`.�_:_ I't. IrF �� __ F'!.. �.i''.1_.5._.J°d..c. i �_ � �s•y/''ywl�' Fruth.. I`[. Pu_.__—..,.$'3.._..----_._...--__ _— ...
w
-Ft, to..n. F[..— }d'_- -: 4 *.£: e i:.4r a
Sts ....... .. ?:
,'` ..'FS..-, .-*"<^J rC .tir ,•�t ,1�='t` i':irm r 6�rurts,.,..w_._.. €'t. rxr_—._. Fi..,,_.___-
tJ477, —.Ft. l(5, �.� �__,Ft�� V�",'•ai l? k,. RJ,.;:.,.
/-
wtl_ Pas_ ..___. Ft
utn_,.._. ...-Ft. to-.
um- .__—_,Ft-to--_._ .Ft..._._
i,
:rm. .._._.._Ft. izs. -. Ft.__ .._..._--._._.. I•mm—Fi
From—'....
---•-� --�— ➢°roto...._—._.Fi,{tr. .___Ff,_ .__�—_. .._—�_.
nts ..._.—_F t. tn,. _._—.F•'t... ..__.—.._._..... - from—__Fa.—_----
m...... Ft. tv—�.. Ft.
pus. Frocn._._._._—.Ft. to-
-------------
_—_._... —gi
(1. . INFORMATION:
JUL 7.19:93
tdltt��H�.rnan Seruiaes
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Ru
ERTIFICATE
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. n 5 I- M B -to COSA# QQ Li4 D
1. GENERAL INFORMATION Expiration Date: ZzIt9 08
Complete legal description
FOX HILL SUDMSION,
LOT 1. BLOCK
2
Location (site address)
21936 WOODCLIFF DRIVE
• CHIGIAK. AK
99567
Current Property owner(s) SALLY GOBLE Day phone 242-1564
Mailing address PO BOX 671214 * CHUGIAK. AK 99567
Lending agency Day phone
Mailing address
Real Estate Agent LANCE BAILEY w/PRUDENTIAL JACK WHITE Day phone 689-6498
Mailing address 3801 CENTERPOINT DR. 11200 * ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
E
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, base on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that tho -s water supply and/or wastewater disposal system is (are)fe, functional and adequate
for the num �f bgdt oms and type of structure indicated herein. I further vergy [hat based on the
info r rff�O Wired from the Municipality of Anchorage files and from my investrjatr and inspection, the
o is
and/or wastewater disposal system !s(aro) in compliance with all app 'Cable Municipal
arnica codes, ordinances, and regulations in effect at the time of installation. w
Name of Firm GARNESS ENGINEERING GROUP, Ltd. I Phone 337-6179
Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date It 113 /07
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines d Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lost, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system
These conditions are outside the control of the evaluator of the system. Satisfactory tes
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benofrt of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will if confor any legal right whatsoever.
5. DSD SIGNATURE
Approved for ':�)_ bedrooms.
CE -7955
...........• ��i
Disapproved.
Conditional approval for bedrooms, with the filowing stipulations:,:` Y OF
36'I A4
ON-SITE
- PROGRAM .,
Attachments:
COSA Checklist Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort
Nitrate Advisory Other
By; Original Certificate Date: .!9
10 7
(Rev. 71N5)
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragew Street
P.O. Box 1966W
Anchorage, AK 99519650
www.muni.org/onsite
(907) 343 7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: FOX HILL S/0, LOT 1 BLOCK 2 Parcel ID: 051-073-07
A. WELL DATA
Well type PRWE If A, B, or C provide PWSID# N/A
Date completed 4/1993 Sanitary seal (Y/N) YES
Total depth 100 ft. Cased to 40+ ft.
FROM WELL LOG
Data of test 4/1993
Static water level 71 ft,
Well production 25 g,p,m,
WATER SAMPLE RESULTS:
Coliform _0 colonies/100 ml.
Arsenic: 0.547 ug,/L,
B. SEPTICIHOLDING TANK DATA
Well Log (Y/N) YES
WIMS property protected (Y/N) YES
Casing height (above ground) 12+ In.
AT INSPECTION
10/28/2007
70 ft,
9.5 g.p.m.
Nitrate 1.94 mg./L. Other bacteria _0 colonies/100 ml.
Date of sample: 10/29/2007 Collected by: GEG Ltd.
Tank Typo/Material SEPTIC/ STEEL
Tank size 1000 gal, Number of Compartments 2
Foundation deanout (Y/N) YES Depression over tank (YIN) NO
Date Installed 11/7-12/2007
Cleanouts (Y/N) YES
Date of pumping NEW Pumper
C. ABSORPTION FIELD DATA.. w i
4/23-24 1993/
BELOW FINAL QRADE
Date installed 11/7-1 /2007 Soil rating(6.p.d. r ftlbdrm) 1-2/0-8
High water alarm (Y/N) N/A
System type WIDE TRENCH
Length 46'5 7 ft. Width 394/ 5/5 ft. Gravel below pipe 3/4.02 ft.
Total depth •*9.94 ft. EB. absorption area 576 ft' Monitoring tube YES Depression over field NO
Data of adequacy test NEW Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test = In. Water added =gal. New depth =1n.
Elapsed Tune: = min. Final fluid depth = in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN . If yes, give date _
D. LIFT STATION
Date installed Size in gallons Manhote/Acoess
"Pump on" level at _In. "Pump2T I � High water alarm level at in.
natum Cycles tested Meets alar & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent kits 100'+
Public sewer manhole/deanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manurelanimal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property Ilne 5'+ Absorption Heid 5'+
water main
N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line
10'+ Surface water 100'+ Driveway. parking/vehicie storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION .•
1 certify that I have determined through field inspections and. +' ; . fes.....;.*,
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines In ailed on Mit ..... ................
date. Gar ss:
Engineer's Printed Name ,JEFFREY A GARNFSS Pogj CE
Date
COSA Fee �%&"
US i,t Waiver Fee E
Date of Payment j AMW
Receipt Number
(P v. 1trot)
Date of Payment
Receipt Number
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING/ '/,/-y
Parcell.D. 051-073-07 HAA# I in /V /
1. GENERAL INFORMATION Expiration Date:
Complete legal legal description FOX HILL SUBDIVISION; LOT 1, BLOCK 2
Location (site address or directions) 21936 WOODCLIFF DRIVE * CHUGIAK, AK 99567
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
SCOTT GLOVER Day phone 688-5398
21936 WOODCLIFF DRIVE * CHUGIAK, AK 99567
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
Day phone
Day phone
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served,by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid
water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water
system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's
work.
PPA1)
/Vote: Alaska Water and Wastewater Consultants, inc. shall be paid $ at, orprior
to closing for the engineering services provided.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. i further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AKWWC, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Phone 337-6179
Date 7 � C 2
bedrooms, with the flowing stipulations:
Manitenance Agreements
Supplemental Engineer's Reort
Other
WATER AND
PROGRAM .'
By: Original Certificate Date:�'�
(Rev. 12101)
Municipality of Anchorage A
Development Services Department W,
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FOX HILL S/D; LOT 1, BLOCK 2 Parcel ID: 051-073-07
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 4/1993 Sanitary seal (Y/N) YES
Total depth 100 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test 4/1993
Static water level 71 ft.
Well production 25 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 1.51 mg./L.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/3/2002
74
WIT-]
Other bacteria 0 colonies/100 ml.
Arsenic: N/A mg./L. Date of sample: 6/4/2002 Collected by: AKWWC, INC.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material STEEL Date installed 4/23-24/1993
Tank size 1000 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (YIN) N/A
Date of pumping 6/15/2002 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 4/23-24/1993 Soil rating OE> ft2/bdrm) 1_2 System type WIDE TRENCH
Length 46 ft. Width 5 ft. Gravel below pipe 3 ft.
Total depth 11 ft. Eff. absorption area 394 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 6/17/2002 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption Feld before test 11 in. Water added 9 14 gal. New depth 36 in.
Elapsed Time: 605 min. Final fluid depth 27 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at _in.
Cycles
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
100'+
Absorption field on lot
100'+
Public sewer main
N/A
Sewer /septic service line
25'+
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10,+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 certify that t have determined through field inspections andQ Y*
review of Municipal records that the above systems are in """' ' ' "" • "' ....... .. • •
conformance with MOA HAA guidelines in effect on this date.
Engineer's Print d N me JEFFREY A. DARNESS vQ��9.• C 7953
1 nnt o
Date % f 9 jZ �u4O�nProfessiol,
HAA Fee $ 3175.
Date of Payment 'A/a, 1da—
Receipt Number. ®""Z11 C,5 G1,
(Rev. 12101)
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # n6 1 — IQ1)1- CD HAA # � ('_-)"1 r�n �,InSc
1. GENERAL INFORMATION
Complete legal description L 19Z F& -g 4,,1) S�lD
Location (site address or directions)
Property owner An An nf� C.o-n4v�-41-1/Yaol Mhers Day phone 6881�3/p
Mailing address
eo$o?' 6 -4o4 -9s A\<, 995��-
Lending agency Day phone
Mailing address
Agent Day phone
Address
Unless otherwise requested, HAA"wi I! be h for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well )<
Community well
Public water
NOTE: if community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
7M25 (Rev. 1/91) Front MOA#21
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as.of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
9Cot
Address
Engineer's signature
6.- DHHS SIGNATURE
� Approved for
Disapproved.
'j
Sbedrooms.
Conditional approval for
Additional Comments
346- woo/ 654- 96 !l-8
Date
1�0•30.915 —
bedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
r
Municipality of Anchorage
Department of Health & Human Services _
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L 1 Y3 2 4 11 S A> Parcel LD
A. WELL DATA
Well type �l?1VY�T6 If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed 4/93 Driller 5up-L1VA2J wATe'k
Total depth IDD Casedto IOU Casing height 3ovE G2f�l
Sanitary seal (Y/N) `f Wires properly protected (Y/N) y
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
4/93
711 13.x.
ZS
g.p.m.
95,
SEPARATION DISTANCES FROM WELL TO:
r(at
Septic/holding tank on lot
Absorption field on lot —
Public sewer main
Sewer service line -
1 46
-4 Z-00'
S
AT INSPECTION
; On adjacent lots
d- loo'
; On adjacent lots I `E"�
Public sewer manhole/cleanout tZoo
Petroleum tank +) bd
WATER SAMPLE RESULTS:
Coliform Nitrate i` 6� Other bacteria
Date of sample: 6" Z4-93 Collected by: t�L'
B. SEPTIC/HOLDING TANK DATA
Date installed VV0 7-30 993 Tank size rvoo q�l
� Y
Cleanouts (Y/N) Foundation cleanout (Y/N)
High water alarm (Y/N)
Date of pumping
Compartments
Z
V A Alarm tested (Y/N;
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on IOL I (�, 8 On adjacent lots + I�
i s
To property lino 4G.Absorption field 4
Surface water/drainage +1�
72-026 (Rev 7/91) Front
Depression (Y/N)
N
Foundation
Water main/service line -r loo'
CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
Manufacturer
Manhole/Access )
"Pump on" level at "Pump off' level at
s.
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE_,,,FR6M LIFT STATION TO:
Well on lot
D. ABSORPTION FIELD DATA
On adjacent lots
Cycles tested
Surface water
Date installed AeyI 1 1993 Soil rating l' Z� 5Pd ISS System type -DEEP u,tvL enol{
Length 4�- Width S ' Gravel thickness 3 ' Total depth III
Total absorption area '941 Cleanouts present (Y/N)
Depression over field (Y/N) N
Results (pass/fail)
Date of adequacy test N0711) 51y5t m
for
Peroxide treatment (past 12 months) (Y/N) 0 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 11-6 On adjacent lots 14-31 Property line 34'
To building foundation 5D To existing or abandoned system on lot
On adjacent lots
Surface water
am
+)06' Cutbank "f 100 Water main/service line +--A 00
t I0p
Curtain drain 4-A C&
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on
Signature
Co7.s'}Y c-�ra.q 1r�eS�✓S
Engineer's Name 2; oO\
C�^Olri f}K i � ssis
Date tO' 30
HAA Fee $ %
Date of Payment
Receipt Number
72-026 Rev. 3/91) Back MOA 21
Waiver Fee: $
Date of Payment
Receipt Number
CE'
r v}esya
4�
bedrooms
of this inspection.
07/03/02 WED 12:26 FAX 1 907 696 3297 MAIL BOXES ETC
5!6" Asher found each corner
N 69 - `A'21 E —559-08
o N rarrw �
2
N84- 7-5oW (NR) ,"S4419
herebyy .... Gm, Fly that a survey of lot 7 Bloch E rot Nill aubdlvision vas aeae
ril 30, 1991 erd that the iaprovemmts situated thereon are within the PrMA
nes and do not overlap or encroach on the property Lying adjeeent thereto, that
proveaents on property Lying ad scent thereto enorweh on the promisee In quest
d that there ere no roadwaYs, trens01ieslon tinea or other visible ceeeaants on a
operty except as sham hereon. tt is the responsibility of the owner to datermine
istsnoe of any tesetknts, cov'4 to or restrictions which do not appear an
,Carded aubdlvlelon Plat. Under no circumstance■ should any data Mrson oa Used
nstruotion or for astebtishino boundary or 460100 lines.
Ked in MchoraQe, AK, April 30, 1993
CONSTRUCTING 1SUGI11BZRS AS -BUILT 6URVSY
9601 Buddy Warner Dr
Anchorage, UP 99516
366-3000 694-9098 low
,oL1
Cif 003
Cocuaar
oocuac+ir
pfPRPAIV pg1Ve
L9461it.
R= 2o.ao
RAL